"D.S.M.-5 promises to be a disaster... it will introduce many new and unproven diagnoses that will medicalize normality...."

Despite some last-minute changes, there are big problems, says Allen Frances, who led the task force that produced D.S.M.-4.

[T]he D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts....

Frances rejects the accusation that the D.S.M. is "shilling for drug companies":

The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role....

Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists....

"I Had Asperger Syndrome. Briefly."

Writes Benjamin Nugent:

As I came into my adult personality, it became clear to me and my mother that I didn’t have Asperger syndrome....

I wonder: If I had been born five years later and given the diagnosis at the more impressionable age of 12, what would have happened?...

The authors of the next edition of the diagnostic manual, the D.S.M.-5, are considering a narrower definition of the autism spectrum. This may reverse the drastic increase in Asperger diagnoses that has taken place over the last 10 to 15 years....

The definition should be narrowed. I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn’t true.

I see that Nugent has a book called "American Nerd: The Story of My People." Great title. I'm going to download it right now.

Depriving people who crave attention from getting attention?

DSM-5 eliminates narcissism as an official personality disorder.

The conflict is nowhere near as amusingly ironic as my post title or the headline at the link suggests.

Raisins, orgasms... what's the difference?

Here's another big NYT Magazine article for women that I didn't want to read, but I'm reading now to use in a Bloggingheads episode. It's been on the most-emailed list all week, this "Women Who Want to Want" business. I looked at it when it came out and the intro about staring at raisins really irritated me. I felt like I was reading the 1969 bestseller "The Sensuous Woman" again. 40 years later, I still remember the advice — for women in search of an orgasm — to get an ice cream cone and pay a whole lot of attention to every detail of the thing. But jeez, at least you got an ice cream cone. Orgasm or not. In 2009, it's a damned raisin?!

"I’d like you to start by examining your raisin... Study its shape, its contours, its folds. Touch the raisin with a finger. Look into the valleys and peaks, the highlights and dark crevasses. Lift the raisin to your lips."

This is going to help you want to have sex — to "want to want"? When I read that, I want nothing. Nothing at all. And get that raisin out of my face.

But I will go on, because I said I'd talk about it. Get past the raisin.

[Lori] Brotto is careful to keep in mind that not all women who feel erotically uncharged are desperate to change. Some may not be dismayed in the least.... [B]etween 7 and 15 percent of all young and middle-aged women... feel distressed over the absence of desire....

So you could either find a way to feel sexual desire or get over feeling bad about the way you really do feel.

Brotto is now studying... a sample of 70 women who... are sent home with assignments — to observe their bodies in the shower and describe themselves physically in precise and neutral language, in phrases that hold no judgment; and, after another session, to repeat over and over, “My body is alive and sexual,” no matter if they believe it. They are taught about research that shows that belief doesn’t matter, that the feeling will follow the declaration. And they are instructed, in their sessions, to place the raisins in their mouths, to “notice where the tongue is, notice the saliva building up in your mouth . . . notice the trajectory of the flavor as it bursts forth, the flood of saliva, how the flavor changes from your body’s chemistry.”

Back to that raisin. Is there a fruity nugget in this big bowl of oatmeal? Is it that women really have sexual feelings, but they emerge during a sexual encounter and may go unnoticed because we aren't good at noticing them? Or is this mainly about defining mental disorders in the D.S.M. — there's something called hypoactive sexual desire disorder (H.S.D.D.)? I'd like to hear less about raisins and Buddhist — it's always Buddhist — techniques of mindfulness or whatever, and more about who's channeling money where....

As is so often true in the poorly financed realm of sex research....

"Caribou Barbie is one nutty puppy," says Maureen Dowd, who wants to be sure you know that Sarah Palin is crazy.

Yes, yes, Palin is crazy. I'm hearing it and hearing it, and naturally, my working theory is that Palin's opponents are taking advantage of the opportunity to paint a vivid picture in the public mind. Crazy, crazy, cah-ray-zeeeee.

Dowd does the diagnosis, plucking a term out of the Diagnostic and Statistical Manual of Mental Disorders or rather plucking a term out of Todd Purdum's Vanity Fair hit-piece:

And so it was, Todd Purdum learned, as he traveled Alaska reporting on Palin for Vanity Fair, that the governor’s erratic and egoistic behavior has been a source of concern for people there.

“Several told me, independently of one another,” Purdum writes, “that they had consulted the definition of ‘narcissistic personality disorder’ in the Diagnostic and Statistical Manual of Mental Disorders — ‘a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy’ — and thought it fit her perfectly.”

Oh! Lord help us! There were people there! There were several. Oh, my lord. Several! Several told Purdum that they were the sort of jackasses that go flipping through the DSM to leverage their displeasure with a powerful person in their vicinity.

Memo to Purdum, Dowd, and the several people there in Alaska: Everybody who runs for high office will have a lot of check marks on the DSM list of symptoms of "narcissistic personality disorder."

I mean, maybe Fred Thompson didn't, but you see, it's a problem if you don't have these things. Bill Clinton, Hillary Clinton, Barack Obama, Joe Biden, etc. etc. — who among them lacks a pervasive pattern of grandiosity, need for admiration, blah blah blah? Oh, but they have empathy, you burble. Bullshit! Watch all the Democrats try to claim the empathy loophole to the narcissistic personality disorder diagnosis. Ha! Bullshit! They all have it. And don't throw your money at a prospective candidate who doesn't. He'll poop out, like Fred.

Memo to the good folks who construct the Diagnostic and Statistical Manual: Consider constructing an official disorder definition that will perfectly fit the kind of people who try to understand human individuals in their vicinity by consulting DSM checklists.

***

The link goes, of course, to the NYT, so there's no link to the Vanity Fair article upon which Dowd relies so heavily. Link withholding — a symptom on what DSM disorder checklist?

If you were blind, would you want a Seeing Eye dog...

... or a Seeing Eye miniature horse — a black and white one named Panda?

"[M]iniature horses are mild-mannered, trainable and less threatening than large dogs. They’re naturally cautious and have exceptional vision, with eyes set far apart for nearly 360-degree range. Plus, they’re herd animals, so they instinctively synchronize their movements with others. But the biggest reason is age: miniature horses can live and work for more than 30 years."

And they seem pretty cool. So cool that maybe you're thinking you want one even though you are not blind. Service animals, they're not just for blind people.

I was thinking I'd like a nice big protective dog to walk with me everywhere, down to campus, into the buildings, into the classroom. What problem/disability would I need to get that privilege? Anxiety?

[A] growing number of people believe the world of service animals has gotten out of control: first it was guide dogs for the blind; now it’s monkeys for quadriplegia and agoraphobia, guide miniature horses, a goat for muscular dystrophy, a parrot for psychosis and any number of animals for anxiety, including cats, ferrets, pigs, at least one iguana and a duck.

Oh, yeah! Anxiety!

They’re all showing up in stores and in restaurants, which is perfectly legal because the Americans With Disabilities Act (A.D.A.) requires that service animals be allowed wherever their owners want to go.

Come on, psychiatrists! Just put Sense of Entitlement Syndrome in the DSM and help us all out.

I don't want to make this post too long. I'm into Twittery terseness today. But the article is long. I'll just flag 2 things:

1. Jim Eggers, a man whose parrot purportedly keeps him from "snapping": "'I have bipolar disorder with psychotic tendencies,' he told me as he sucked down a green-apple smoothie. 'Homicidal feelings too.'" Now, I'm officially afraid of people who drink green-apple smoothies. I'm afraid of green apples. Hell, I'm afraid of people who use straws. Can I have a parrot in a restaurant now?

2. "Business owners and their employees often couldn’t distinguish the genuine from the bogus. To protect the disabled from intrusive questions about their medical histories, the A.D.A. makes it illegal to ask what disorder an animal helps with. You also can’t ask for proof that a person is disabled or a demonstration of an animal’s 'tasks.' There is no certification process for service animals (though there are Web sites where anyone can buy an official-looking card that says they have a certified service animal, no documentation required). The only questions businesses can ask are 'Is that a trained service animal?' and 'What task is it trained to do?'" Apparently, soothe me is the wrong answer.

This is a tough issue. Too many conflicting interests. You have the people who obviously need service animals with trained service animals like Seeing Eye dogs, people who are just completely abusively bringing animals everywhere, and everything in between. And you have business owners who want to be compassionate and who accept that they must follow the law, but who don't want to be played and who are afraid of losing customers and of being sued. And you have all the people who are annoyed, allergic, and afraid of all the animals other people are imposing on them.

I have no answer of my own for this, but gee, wasn't that little horsey cute? I can see why the NYT Magazine led off its article with the blind woman and her Panda!

Jeremy thinks he's special. Or not. Funny that his response to the charge "narcissistic" was to go to the DSM and mine was to recast it as sin, which may indicate that law is not a social science, though the Law School is in the Social Sciences Division here. Or it may indicate that Jeremy's natural instincts are the sort that cause a person to become a political liberal and mine are the sort that pull in the other direction: If something is wrong, do you think of it as a disease to be cured or a personal failing for which the individual should take responsibility? Anyway, Nina's response is to be off to Japan, and she promises to blog about the extent to which she becomes lost in translation. She's flying to Japan over the Atlantic Ocean and she's not going to Tokyo, so it's all very mysterious! The original "friends" that called blogging narcissistic were/was apparently only one person, whose response was to start her own blog. So you see, just like your mother always told you: they're just jealous. And: you are special!